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V <br /> Burnett County Office of Zoning Administratord o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < moo^ �� <br /> N \ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n W <br /> / . .(. .,.w.....Gt....r . ...kq .............................. .........{' ..,�x....6K,..1 �...$...................................... <br /> OWNER (please print) CONTRreCTOR or SURVEYOR or AGENT <br /> ......�.9.79.c......1.�.7.s �� ....�� . ....�...-�.... � �.... t�83 <br /> ..................................... <br /> ADDRESS G ADDRESS <br /> ADD R.l.. 44y.... M,,.......s.�...�.7..}........................ ............................................................................................ <br /> ADDRESS <br /> ........................................................................................... . .......................................................................................... <br /> PHONE PHONE .tel <br /> G <br /> ........................................................................................... .WEL.. ... ...L..DRILL'R-I'.. ....................................................................... <br /> PLUMBER LE.. R <br /> p <br /> ADDRESS ADDRESS <br /> ct <br /> ........................................................................................... ................................................... ....................................... p o <br /> PHONE PHONE Z m r <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o ,( <br /> New Building ....,,,,,. Type of Constructi n: No. Bedrooms .......... 'j 'o <br /> m i <br /> Addition ... - ,•„ ••Srtf,a,;�„,�e�„�L.......... Septic Tank Size Gals. .......... E <br /> )..... <br /> Sanitary .......... Size ..../,Z.... ft. x ...�6....... ft. ....•.•••• <br /> Filling/Grading .......... Height... .... St *es .../........... 4a. Absorption Field Site: .1 I <br /> ggJ <br /> Moving .......... Area ....(Ssf..Cl'— Soil Type .................................... :V� o i <br /> Mobile Home Slope .......................................... <br /> .......... N, <br /> Priv Fare. Rate ................................... <br /> Privy ...... 3. Use (describe exactly, 1 -family � <br /> Well •..•.•.•.. home,garage, motel, etc.) Dry Well .......... t <br /> Subdivision .......... .................................................... Seepage Trench .......... <br /> Camping Unit .......... Privy .......... k, <br /> .................................................... Seepage Bed---------------------------------------------------------------------- <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road n Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 0- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- <br /> n <br /> 5. Lot Size: Fig. A. 6. Loco on: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ...... 5....k{.....................:....................................... _ (” <br /> _ n <br /> F ; <br /> l o L' ° <br /> all <br /> e _ <br /> 0 <br /> 3 <br /> P <br /> X39` ty �. <br /> n( V <br /> IF � <br /> :0 N N 9 G y Z <br /> K NaC <br /> a v, < ,fro -o <br /> m„ m <br /> ZO O D n <br /> o 0 n a M <br /> $— CD O <br /> ... . .... .... ........................................ ... .............................. o C <br /> ign are Owner o Agent Date — <br /> X 70 <br /> Remarks ......�. S. .. .a : . . . . ' <br /> ...... . . ............................................................................................................................. <br /> en ' <br /> C <br /> Inspection Date ��99��� ��,�, i 1F` f ' 00 ' N m <br /> p ....................................... ..K!.'(.!!^��. .............•.. ..�..�.;�........................ o u . . . u� m <br /> Zoning Ad lnirf strator K-) S $ $ S 8 8 v� <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be merle without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />